Goldstein M, Dunnigan A, Milstein S, Benson D W
Department of Pediatrics, University of Minnesota Hospital.
Am J Cardiol. 1989 Feb 1;63(5):301-6. doi: 10.1016/0002-9149(89)90335-4.
Transesophageal electrophysiologic studies were performed in 58 infants (age less than or equal to 1 year, median 10 days) with electrocardiographically documented orthodromic reciprocating tachycardia (ORT). The aim was to evaluate the occurrence, type and electrophysiologic effects of bundle branch block (BBB) during ORT onset. Of the 58 infants, 25 (43%) had BBB with pacing-induced tachycardia onset. BBB was initiated by single or double premature atrial extrastimuli and by burst atrial pacing; 4 infants also demonstrated BBB with spontaneous ORT onset during transesophageal study. Two of 25 infants had BBB only after intravenous procainamide. Comparison of the 25 infants exhibiting BBB at ORT onset with the 33 infants not demonstrating BBB revealed that age was not statistically different in the 2 groups, but that severity of illness (based on a 1 to 3 scale) was greater (p less than 0.05) and normal QRS ORT cycle length was shorter (p less than 0.02) in the infants with BBB. Of the 25 infants with BBB at ORT onset, 17 had left BBB, 3 had right BBB and 5 had both left and right BBB. Ventriculoatrial interval or cycle length increases during ORT with BBB in 16 of 25 (64%) infants suggested left free wall-accessory atrioventricular connections.(ABSTRACT TRUNCATED AT 250 WORDS)
对58例心电图记录为顺向型房室折返性心动过速（ORT）的婴儿（年龄小于或等于1岁，中位数为10天）进行了经食管电生理研究。目的是评估ORT发作期间束支传导阻滞（BBB）的发生情况、类型和电生理效应。在这58例婴儿中，25例（43%）在起搏诱发心动过速发作时有BBB。BBB由单个或双个房性早搏刺激以及短阵房性起搏引发；4例婴儿在经食管研究期间自发ORT发作时也出现了BBB。25例婴儿中有2例仅在静脉注射普鲁卡因胺后出现BBB。将25例ORT发作时出现BBB的婴儿与33例未出现BBB的婴儿进行比较，发现两组婴儿的年龄无统计学差异，但出现BBB的婴儿病情严重程度（基于1至3级评分）更高（p<0.05），正常QRS波ORT周期长度更短（p<0.02）。在25例ORT发作时出现BBB的婴儿中，17例为左束支传导阻滞，3例为右束支传导阻滞，5例同时有左、右束支传导阻滞。25例婴儿中有16例（64%）在ORT发作伴BBB时心室房性间期或周期长度增加，提示左侧游离壁房室旁道连接。（摘要截选至250字）
